A meta-study of qualitative research examining determinants of children’s independent active free play

Charting a Professional Course: A Review of Mentorship in Medicine

BackgroundThis review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks...

Antimicrobial resistance is a global health threat, partly driven by inappropriate antibiotic prescriptions for acute medical patients in hospitals. To provide a systematic review of qualitative research on antibiotic prescribing decisions in hospitals worldwide, including broad-spectrum antibiotic use. A systematic search of qualitative research on antibiotic prescribing for adult hospital patients published between 2007 and 2017 was conducted. Drawing on the Health Belief Model, a framework synthesis was conducted to assess threat perceptions associated with antimicrobial resistance, and perceived benefits and barriers associated with antibiotic stewardship. The risk of antimicrobial resistance was generally perceived to be serious, but the abstract and long-term nature of its consequences led physicians to doubt personal susceptibility. While prescribers believed in the benefits of optimizing prescribing, the direct link between over-prescribing and antimicrobial resistance was questioned, and prescribers' behaviour change was frequently considered futile when fighting the complex problem of antimicrobial resistance. The salience of individual patient risks was a key barrier to more conservative prescribing. Physicians perceived broad-spectrum antibiotics to be effective and low risk; prescribing broad-spectrum antibiotics involved low cognitive demand and enabled physicians to manage patient expectations. Antibiotic prescribing decisions in low-income countries were shaped by a context of heightened uncertainty and risk due to poor microbiology and infection control services. When tackling antimicrobial resistance, the tensions between immediate individual risks and long-term collective risks need to be taken into account. Efforts to reduce diagnostic uncertainty and to change risk perceptions will be critical in shifting practice.

BackgroundReducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals’ experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care.MethodsA synthesis of qualitative research of health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) statement.ResultsEight studies reported in nine papers were included, reporting on the views of 190 health professionals/key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual’s ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessationConclusionsThe review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship in any interaction. The review also highlights a widespread professional perception of the barriers associated with helping women give up smoking in pregnancy, particularly for those in disadvantaged circumstances. Improving the quality and accessibility of evidence on effective healthcare interventions, including evidence on ‘what works’ to support smoking cessation in disadvantaged groups, should therefore be a priority.PROSPERO 2013CRD42013004170.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2961-9) contains supplementary material, which is available to authorized users.

Patients’ experiences and perspectives of post-hospital follow-up care to improve physical recovery for intensive care survivors: A Systematic Review of Qualitative Research

ABSTRACTWe performed a systematic review of qualitative research on interventions to reduce homophobia. Specifically, we conducted a thematic analysis of participant feedback given in 30 qualitative and mixed-methods studies. Participants often described interventions as “eye-opening.” However, they also criticized many interventions for their mismatch with the social, historical, or institutional context in which they were conducted. Some participants rejected the interventions altogether, describing them as offensive or disgusting. We drew three conclusions. First, participants not only were actively making sense of the interventions but also were often aware of philosophical and political tensions (especially liberal vs. queer approaches). Second, participants sometimes used the perceived inadequacy of the intervention for the local context as an argument to resist change. Finally, tensions in participant feedback (eye-opening vs. disgusting) can be read as evidence that reducing homophobia is “dirty work”: such work is both vital for society and despised by many.

Background : Family members and caregivers of children with autism spectrum disorder (ASD) report challenges and barriers in accessing support networks, which are associated with detrimental impacts on clinical, social, and quality-of-life outcomes. Objective : To explore how parents and caregivers of children with ASD, experience the support network provided by health and education services and the community. Method : This is a systematic review of the qualitative research about health, school and community support networks for parents and caregivers of children with ASD using a thematic synthesis of the studies. We searched the terms in the PubMed, EMBASE, ERIC and APA PsychNet databases for qualitative studies (interviews, focus groups and questionnaires with open questions) and produced a thematic synthesis by codes and themes based on the selected qualitative studies. Results : The synthesis resulted in 24 selected articles. Three themes emerged: health support networks (search for diagnosis, emotional support, post-diagnosis, financial and family impacts, access to specialized services); school support networks (inclusive school, training, emotional support); and community support networks (stigma and social exclusion, judgments, and emotional support). Parents and caregivers of children with ASD perceive difficulties in their trajectories with the various support networks. Conclusions : The limited emotional support received by parents was a common perception in health, school and community networks. Socioeconomic, demographic, ethnic and cultural characteristics seem to influence differently the perceptions on support networks.

The term 'non-utilised appointments' emerged in 2019 but lacks a clear definition. We focus on multiple non-utilised appointments owing to recent advances in understanding 'missingness' in UK health care. Studies on missed appointments show conflicting results regarding interventions such as text messaging owing to oversight of occasional versus repeated missed appointments. Understanding patient and healthcare-related factors in multiple non-utilised appointments is crucial for improving interventions and patient engagement. To identify factors influencing multiple non-utilised appointments from patients' and healthcare providers' perspectives. A systematic review of qualitative research identifying factors that influence multiple non-utilised appointments across diverse global healthcare settings. The review employed a qualitative systematic approach, encompassing diverse papers from multiple databases, irrespective of patient or healthcare provider age, location, or setting. Data analysis followed Thomas and Harden's thematic synthesis method. Themes are presented in alignment with both the health service and patient perspective aspects of the Levesque access model. Ten thousand and eighty-six records were retrieved. Five studies met the inclusion criteria and were analysed. Six key themes influenced appointment utilisation. Healthcare system determinants highlighted provider-patient relationship and professionalism, and healthcare organisation factors role in appointment utilisation. Patient experience and decision making explored personal factors. Additionally, communication, support, and engagement delved into challenges with communication and language, family and social support, and socio-familial barriers to appointment utilisation. Health and wellbeing factors encompassed medical conditions, mental and emotional factors, and psychosocial determinants affecting appointment utilisation. Moreover, financial constraints and socioeconomic factors were identified as significant contributors. Lastly, healthcare access and barriers addressed transportation challenges, accessibility issues, and geographical barriers impacting healthcare access. The analysis reveals complex factors influencing multiple non-utilised appointments. Strong provider-patient relationships improve care accessibility. Flexible scheduling and patient-centred approaches are pivotal, alongside addressing workplace discrimination. Tailored healthcare services and overcoming geographical barriers are essential. Ensuring safety, accessibility, and communication, while supporting vulnerable groups and mental health needs, are necessary. Equitable access to services and alternative transportation solutions are essential for comprehensive healthcare delivery.

Review question / Objective: In clinical trials, what are the process factors and improvement strategies that may affect patient compliance and retention based on qualitative research? What is the quality of the evidence from these qualitative studies? Condition being studied: The patient compliance and retention (PCR) in RCTs are the ability to avoid noncompliance with medication and attendance appointments and loss of follow-up visits, including loss of contact with the research team (including subsequent loss of follow-up during the study and failure of the research team to re-establish contact).PCR is critical to determining the efficacy of drugs in clinical trials. Poor PCR may result in missing essential data, which affect the authenticity of clinical trial results. Since the understanding of process factors and improvement measures is highly personal, the use of qualitative interviews is very useful for investigating these because they allow patients and researchers in clinical trials to express their experiences in their own words. Although there are some qualitative studies on process factors and improvement strategies, no systematic reviews of qualitative research exploring process factors and improvement strategies has been found. Thus a synthesis and rigorous evaluation of the available data is still very necessary.

The aim of this study was to summarize the existing qualitative literature in order to develop the evidence base for understanding and managing weight loss and anorexia, in order to make recommendations for clinical practice. A systematic search was performed to retrieve English language studies using electronic search and manual checks of selected reference lists. Keywords included qualitative, cancer cachexia, weight loss, anorexia, appetite, malnutrition, food, eating, and drinking. The selection and appraisal of papers were undertaken by two reviewers. Twenty-one qualitative articles were included in the review. There were three major findings emerging from the previous qualitative studies including ‘the multidimensionality of weight loss and anorexia experience’, ‘patients and caregivers' responses to coping with weight loss and anorexia’, and ‘clinical assessment and management of weight loss and anorexia’. The literature review revealed the multidimensional nature of cachexia and weight loss experience by patients and caregivers, which was not recognized and adequately managed by healthcare professionals. Future research in this area would be helpful in enabling a deeper understanding of the complexity of cachexia and weight loss experience in order to move forward to develop an optimal model of supportive care for patients and caregivers.

Patient perception of rehabilitation in the community following hip fracture surgery. A systematic review of qualitative research

The relationship between young adulthood, women and psychosis was the focus for this systematic review. Age and gender are factors that can influence responses to illness. Research indicates that there are differences in how young men and women are affected biologically and psychosocially, including the presentation of a constellation of symptoms, response to anti-psychotic medications and how they assess their life circumstances. Yet in literature that examines experiences of young people with psychosis, the specific needs of young women are usually not presented separately. To better understand and address young adult women's healthcare and social service needs, a synthesis of evidence addressing the relationship between young adulthood, women and psychosis is needed. The aim of this systematic review was to synthesize the best available evidence on the experiences of young adult women (aged 18-35 years) living with a psychotic illness in the community. Specifically, the review question was:What are the experiences of young adult women living with a psychotic illness? Participants were young women between 18 and 35 years of age who were living with a psychotic illness in the community. The phenomenon of interest was the experiences of living with a psychotic illness of women aged 18-35 years in the community. Experiences were defined broadly as and inclusive of perceptions and experiences with health and social systems. The context for this review was the community setting. The current review included studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and the qualitative component of mixed methods studies. A three-step search strategy was used to locate both published and unpublished studies. The search was limited to studies published from 1995 to the search date of May 13, 2015. Two reviewers independently appraised the nine included studies using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) assessment tool. Data were extracted from included papers using the standardized data extraction tool from JBI-QARI. Two reviewers independently reviewed the extracted findings to identify potential categories to pool similar findings. A third member of the team met with the reviewers to collaboratively review these derived categories to create a meta-synthesis that reflected a comprehensive set of synthesized findings. Based on the thematic findings from nine qualitative studies, two synthesized findings were identified: (1) the complexity of living with psychosis and finding health, and (2) the presence of harming and healing relationships in young women's lives. The included studies explored a range of experiences relevant for women within the broader phenomenon of experiences of living with a psychotic illness, including experiences within healthcare and social systems. The systematic exploration of the literature resulted in identification of nine studies of moderate-to-high methodological quality that met the inclusion criteria. The ConQual evaluation of the level of evidence resulted in synthesized finding 1 (the complexity of living with psychosis and finding health) rated as moderate and synthesized finding 2 (the presence of harming and healing relationships in young women's lives) rated as low. Practitioners can use these findings to guide practice. Further research exploring other experiences relevant for this population is needed.

To identify the symptoms and quality of life impacts that are important from the perspective of patients with varicose veins and to compare identified themes to items in varicose vein patient-reported outcome measures (PROMs). Varicose veins are common worldwide and are considered a chronic condition with implications for quality of life. Treatment is predominantly conservative; therefore, understanding patients' experiences of living with varicose veins is important to inform the provision of clinical care. PROMs are often used to collect data about patients' quality of life. Thematic synthesis of qualitative research reported according to ENTREQ guidelines. Multiple electronic databases, including MEDLINE and CINAHL, were systematically searched to identify qualitative research examining experiences of adults with varicose veins. Thematic synthesis was then conducted on the included studies. Three studies met the inclusion criteria; the quality of the studies was high. The range and intensity of reported symptoms and participant's experiences of living with varicose veins were varied. Five overarching themes were identified: physical, psychological and social impact of varicose veins, adapting to varicose veins and reasons for seeking treatment. The overall key theme to emerge was adaptation, with patients demonstrating how they adapted to the various impacts. This review demonstrates that varicose veins have a wide range of symptoms and may have a significant impact on quality of life; people made significant adaptations to enable them to live their lives as fully as possible. Healthcare professionals need to be aware of the range of symptoms and their impact on quality of life. The use of PROMs to gather information about quality of life and symptoms is well established globally; however, PROMs currently used may not capture the full extent of the impact on patient's quality of life.

ABSTRACTBackgroundIt is important to hear the perspectives of people with intellectual disabilities on dementia. This review aimed to explore views and experiences of dementia from the perspective of people with intellectual disabilities and methodologies enabling people with intellectual disabilities and dementia to participate in qualitative research.MethodsStudies were identified in database searches, along with reference and citation searches. Qualitative data were reviewed using thematic synthesis and risk of bias assessed using the Critical Appraisal Skills Programme (2018). Methodologies used to include participants with intellectual disabilities and dementia were reviewed.ResultsFindings from 11 studies, with a total of 47 participants, highlighted loss of ability, relationships and connection associated with dementia, counteracted by support from others, and maintenance of a sense of self through choice, relational connection and competence. A range of methodologies were identified to enable participants with intellectual disabilities and dementia to participate in research.ConclusionsThis review highlights emerging, albeit demographically limited, qualitative research in this field. It suggests ways to build on this including methodologies to facilitate inclusion of people with intellectual disabilities and dementia in further research.

WHAT IS KNOWN ON THE SUBJECT?: Seclusion involves isolating a patient in a room away from other patients in order to contain aggressive behaviour, and it is used in psychiatric hospitals. Research has found that seclusion is often viewed by patients as negative; however, there is limited in-depth understanding of the deeply personal experience. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review found that the published research may have flaws with the quality of analysis, mainly due to limited researcher reflexivity. The review of qualitative research revealed that during seclusion, patients feel vulnerable, neglected and abused, disconnected from the experience and that it is dangerous to their mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: For clinicians facilitating the seclusion process to use their therapeutic skills to provide patients with a sense of being cared for. For clinical supervision to allow space to explore interpersonal dynamics during seclusion in order to enhance therapeutic staff-patient interaction. Abstract Introduction There is limited understanding of patients' seclusion experience. A 2013 systematic review provides some insight; however, more knowledge is required in order to improve patient care. This is a systematic review of qualitative research into the patient experience of seclusion. The qualitative focus enables the phenomena to be the central focus. Question "What are adult psychiatric inpatients' experience of seclusion?" and "What is the quality of the applicable research?" Method Electronic searches for qualitative research published between 2006 and 2017 were undertaken. Data were excluded if it was not explicitly related to seclusion. Research was appraised using three standardized appraisal criterion. Themes were generated through thematic synthesis. Results Eight papers met inclusion criteria; four had been translated into English. Four themes were identified: "feeling vulnerable," "feeling neglected and abused," "disconnecting" and "seclusion is dangerous to mental health." Participants felt vulnerable and without control. They experienced staff and room as neglectful and abusive. Participants mentally disconnected. The experience threatened participants' mental health. Discussion Participants' experience is an amalgamation of interpersonal experience and the environment. Disconnecting may be a coping strategy. Implications for practice The findings have implications for seclusion practice, staff training and clinical supervision. Specific attention needs to be paid to the staff-patient interaction.